Claims Analyst ~ Dental Insurance
About The Position
Join Northeast Delta Dental, recognized as one of the 2025 Best Companies to Work For in New Hampshire. We are seeking a full-time Claims Analyst for our Claims Edit Department in Concord, NH. This role is crucial for ensuring the accurate adjudication, refunds, and adjustments of dental claims. The analyst will review, research, and return suspended dental claims in accordance with departmental processes. This is a hybrid position requiring 2-3 days in the office after initial on-site training. Candidates must reside in NH or MA and be authorized to work in the US without sponsorship.
Requirements
- At least two years of claims processing or insurance-related experience, or an equivalent combination of training, experience, and/or education.
- Proficiency in Microsoft Excel and Word.
- Thorough knowledge of CDT coding and dental terminology.
- Ability to perform routine mathematical computations and calculations.
- Must live in NH or MA.
- Must be authorized to work for any employer in the United States without sponsorship now and in the future.
Responsibilities
- Adjudicates claims using Northeast Delta Dental and New England Dental Administrators, LLC, processing policies by reviewing, correcting, editing, and researching suspended claims.
- Contacts dental offices as necessary to obtain routine missing information or to correct information.
- Researches, corrects, and processes claims queries.
- Processes claims requiring special handling, special consideration, and manual pricing by following applicable processes for specific programs/groups/benefits (e.g., Ortho, Head Start, Exchanges, New England Dental Administrators, LLC).
- Resolves Dental Coordination of Benefits (COB), Dual Delta, and medical claims based on coordination of benefits guidelines.
- Ensures the accuracy of benefits allocation between primary and secondary dental and medical carriers.
- Calculates refunds for Customer Service staff.
- Verifies coordination of benefits resolutions.
- Provides information in response to questions about claims payments.
- Assures appropriate documentation, X-rays, and/or any applicable notes are attached before forwarding claims to consultant review.
- Reviews claims and returns claims missing information to the dental offices.
Benefits
- Competitive pay
- Health insurance
- Dental insurance
- Vision insurance
- Paid Time Off (PTO)
- Paid holidays
- 401(k)
- Tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
